Miriam Berkowitz, left, and Valerie Stessin at the French Hospital of St. Louis.

When Miriam Berkowitz set off from Montreal to Boston to study international relations and Russian at Harvard University, becoming a rabbi was not part of her plan. Just the idea of navigating the crowds who might want to chat after kiddush, says the soft-spoken Canadian, seemed exhausting.

“But I had begun reading Torah, and that felt natural,” says Berkowitz, who had grown up in a non-religious home. “I realized that, beyond the pulpit and the socializing, there were many other aspects of being a rabbi – the learning, the teaching, the music, the spirituality and gemilut hasadim [acts of kindness] – that felt right.”

Twenty-odd years later, Berkowitz, 42, is a Conservative rabbi, ordained through the Schechter Rabbinical Seminary in Jerusalem, where she lives with her husband, a fellow rabbi, and three children. But her day-to-day work involves almost no sermons or after-kiddush chatting. She is a chaplain, or a pastoral care provider, having completed hundreds of hours of accredited courses through the U.S.-based program Clinical Pastoral Education (CPE).

Berkowitz is the first to admit that most people in Israel don’t really know what a chaplain or, as it is called here, a spiritual supporter, actually does. Pastoral care is an established field in Canada, Australia, parts of Europe and, especially, in the U.S. -- but in this country it’s still in its infancy. In the U.S., for example, where pastoral care has been around since the 1930s, every hospital today is legally required to offer access to a chaplain as part of a multidisciplinary healthcare team, and chaplains are regularly employed by the army and prison services.

In Israel, the first two programs for studying pastoral care both opened in Jerusalem in 2005: BeRuach, at the department of oncology at Shaare Zedek Medical Center, and Mazorim, based at Hebrew Union College. Soon after, the Schechter Rabbinical Seminary started the first accredited CPE chaplaincy program in the country. Since then, a handful of other programs, of varying length and focus, have cropped up across Israel, many of them sponsored by the New York Federation’s Caring Commission.

And still, it was only this year that the profession began setting up an accreditation system and trying to regulate its qualifications, and graduates of pastoral care programs have found it nearly impossible to find paying jobs, or a rightful place within the medical community. The field is even less well-known among Israel’s Muslims and Christians, and there are few, if any, known trained pastoral caregivers of those religions.

Berkowitz, along with Paris-born Valerie Stessin, 48, a fellow Conservative rabbi and a mother of two who also qualified as a chaplain through CPE, wants to see this change. They are the co-founders of Kashouvot, a pioneering pastoral care organization launched in 2010 that is dedicated to finding placements for CPE-trained chaplains in Israeli retirement homes, hospices, hospitals and elsewhere -- and raising awareness about the field.

“Being a chaplain means helping people of all faiths and identifying their unique sources of meaning and inner strength,” says Stessin, who grew up in a non-religious home in a small town in southwestern France and came to rabbinical studies and chaplaincy later in life, in her case via degrees in special education and Jewish philosophy. “We assist people in coping with the transitions of aging, illness, death and grief as well as identifying areas of joy and growth.”

“We don’t have an agenda,” adds Berkowitz, stressing that while the two women are both rabbis who might use Jewish texts and ritual as points of discussion and inspiration, they are comfortable and equipped to work with people of different religions and secular ones alike. “We want to help patients cope with the situations they are in, and understand them on a spiritual level,” she says.

‘Flexibility is key’

On Thursdays, the women, who juggle fund-raising (Kashouvot is dependent on foundation and private donations) with moving between their places of work and mentoring other CPE students, are usually found at the historic French Hospital of St. Louis, outside Jerusalem’s Old City walls. Founded in the mid-19th century by the Latin patriarch, the French hospital, run by the Sisters of St. Joseph, has some 50 beds filled with Jewish, Muslim and Christian patients, many of them terminally ill. It was one of the first hospitals in Israel to embrace pastoral care.

The hospital has doctors, nurses, a dedicated social worker, a rabbi and dozens of volunteers from around the world. And then there are Berkowitz and Stessin, winding their way down the long hallways, and stepping into the sparse rooms to spend time with the patients.

They do not deal with bureaucracy or liaising with the health-care providers, as social workers might, nor do they help clean or physically take care of the sick, as nurses, volunteers and doctors, in some capacity or another, do. They also have a different function than that of the hospital rabbi, who might deal with prayer services, kosher food and occasional ethical decisions – but is not typically trained in spiritual counseling or experienced in interfaith work.

“They do their own thing,” says Fadi Nowisser, a Christian Arab nurse’s assistant at the French Hospital, speaking of Berkowitz and Stessin. “They put a smile in the patients hearts and help [them] express themselves.”

Sometimes, says Berkowitz, she and Stessin will sit beside a patient and talk -- about hopes or love, regrets, family, or any other topic the patient feels like addressing. There are those who want to talk about funeral arrangements, and those who want to discuss their future plans. There are some who have no one else to talk to and others who have many visitors but find they can’t broach certain important topics with them. “Flexibility is key,” says Berkowitz. “I don’t have a message for anyone. I go with them where they wish to go.”

Sometimes there is nothing to say. Berkowitz or Stessin might then sing with their patients or pray or read texts, holy or otherwise or simply sit and hold someone’s hand.

If they can, the women try to move their work outside the hospital or hospice walls, taking patients out for a trip, a concert, to a museum or for a manicure. One elderly Russian immigrant diagnosed with MS who has no family in the country asked Berkowitz and Stessin to go see “something beautiful in Israel.” They took him to the Dead Sea for an afternoon. A woman with late-stage cancer expressed her desire to get dressed up and go out for dinner at a restaurant -- to feel, if only for a few hours, like her life was a different one.

Pastoral care, it is important to note, is a part of, but distinct from, palliative care. The later is an interdisciplinary approach focused on relieving suffering and bettering quality of life for patients and families coping with potentially life-threatening illnesses. Palliative care uses input from physicians, pharmacists, nurses, social workers and psychologists – as well as from chaplains.

“Most clinicians, certainly those involved in palliative care, should be spiritual generalists in that they are able to identify spiritual needs or distress,” says Elisha Waldman, a pediatric oncologist and palliative care specialist at Hadassah Hospital. “Chaplains trained in pastoral care are spiritual specialists who provide an invaluable service in their ability to more deeply explore and provide support for those spiritual needs.”

Ruhama Weiss, who runs the Mazorim pastoral care training at HUC, emphasizes that pastoral care involves spiritual healing and guidance for those in need, in whatever situation they find themselves. People nearing the end of life tend to be more reflective and spiritually open (and also have more free time), they are, so to speak, a natural fit for pastoral care. But such care can be helpful to anyone going through a life transition, stresses Weiss -- be it anything from a curable illness to divorce to conversion to childbirth or any other meaningful life change.

“You don’t have to reach the end of life to start asking questions,” says Berkowitz. “Pastoral care is a way to bring holiness to the room, help people reconnect to whatever source and tradition they chose—and help them feel peace.”